The URL can be used to link to this page

Home My WebLink About#721 FMC RESULTS 7-17-12MONITORING SYSTEM CERTIFICATION For Use By Al! Jurisdictions Within the State ofCalifornia Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each monitoringsystem control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner /operator. The owner /operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General information Facility Name: #7721 Fastrip #22 (North) Bldg. No.: Site Address: 4013 South H Street City: Bakersfield Zip: 93304 Facility Contact Person: Omero Garcia Make /Model of Monitoring System: Veeder -Root TLS -350 B. Inventory of Equipment Tested /Certified Check the appropriate boxes to indicatespecific equipment inspected/serviced: Contact Phone No.: (661) 393 -7000 Date of Testing/Servicing: 7/1712012 Tank ID: 12000 gal. Regular Tank ID: 12000 gal. Super In -Tank Gauging Probe. Model: 847390 -107 In= Tank Gauging Probe. Model: 847390 -107 Annular Space or Vault Sensor. Model: 794390 -420 Annular Space or Vault Sensor. Model: 794390 -420 Z Piping Sump / Trench Sensor(s). Model: 794380 -208 Z Piping Sump /Trench Sensor(s). Model: 794380 -208 Fill Sump Sensor(s). Model: Fill Sump Sensor(,), Model: Z Mechanical Line Leak Detector. Model: FX1V Mechanical Line Leak Detector. Model: FX1V Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Z 'rank Overfill / High -Level Sensor. Model: 847390 -107 Z Tank Overfill / High -Level Sensor. Model: 847390 -107 Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2). Tank ID: 12000 gal. Diesel Tank ID: In -Tank Gauging Probe. Model: 847390 -107 In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: 794390 -420 Annular Space or Vault Sensor. Model: Piping Sump / Trench Sensor(s). Model: 794380 -208 Piping Sump /Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: FX1DV Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / Fligh -Level Sensor. Model: 847390 -107 Tank Overfill / High -Level Sensor. Model: Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2). Dispenser ID: 9 & 10 Dispenser ID: 11 & 12 Z Dispenser Containment Sensor(s). Model: 794380 -208 Z Dispenser Containment Sensor(s). Model: 794380 -208 Z Shear Valve(s). Z Shear Valve(s). Dispenser Containment Floats) and Chain(s). Dispenser Containment Floats) and Chain(s). Dispenser ID: 13 & 14 Dispenser ID: 15 & 16 Z Dispenser Containment Sensor(s). Model: 794380 -208 Z Dispenser Containment Sensor(s). Model: 794380 -208 Z Shear Valve(s). Z Shear Valve(s). Dispenser Containment Floats) and Chain(s). Dispenser Containment Floats) and Chain(s). Dispenser ID: 17 & 18 Dispenser ID: 19 & 20 Z Dispenser Containment Sensor(s). Model: 794380 -208 Dispenser Containment Sensor(s). Model: 794380 -208 Z Shear Valve(s). Z Shear Valve(s). Dispenser Containment Floal(s) and Chain(s). Dispenser Containment Floats) and Chain(s). If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification - I certify that the equipment identified in this document was inspected /serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, 1 have also attached a copy of the report; (check all that apply): ® System set -up ® AI rm history report Technician Name (print): Bryan A Self Signature: Certification No.: B37501 License. No.: 804904 Testing Company Name: Confidence UST Services, Inc. Phone No.: (800) 339 -9930 Site Address: 4013 South H Street, Bakersfield, CA 93304 Date of Testing/Servicing: 7/17/2012 Page 1 of 3 Monitoring System Cert(tieation D. Results of Testing /Servicing Software Version Installed: 327.04 Complete the following checklist: Yes No* Is the audible alarm operational? Yes No* Is the visual alarm operational? Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational? Yes No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) N/A operational? Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (Check all that apply) ® Sump /Trench Sensors; ® Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failure /disconnection? ® Yes; No. Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 90% Yes* No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. Yes* No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product; Water. If yes, describe causes in Section E, below. Yes No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, if applicable Yes No* Is all monitoring equipment operational per manufacturer's specifications? In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: I replaced the annular sensor on the 91 (super tank). I also replaced the Diesel LLD (FX1 DV). Page 2 of 3 Monitoring System Certification F. In -Tank Gauging / SIR Equipment: ® Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Yes No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes No* Was accuracy of system product level readings tested? Yes 1 No* Was accuracy of system water level readings tested? Yes No* Were all probes reinstalled properly? Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Complete the following checklist: Check this box if LLDs are not installed. Yes No* For equipment start -up or annual equipment certification, was a leak simulated to verify LLD performance? N/A Check all that apply) Simulated leak rate: ® 3 g.p.h.; 0.1 g.p.h ; 0.2 g.p.h. Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes No* Was the testing apparatus properly calibrated? Yes No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/A or disconnected? Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions N/A or fails a test? Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. Page 3 of 3 T I : UHL VOLIVIR vFTllriRL0 4 .-j C1 0 - P RFHTFE- - 05. u K w% 5-a 5noymo snalooma EII FFO'rUP.E.-,: PFRI(H-IC' 61,11111A]. 151, JUL 17, 20'.' EM I SH 111PIE T-I„T 1-1-3k DD aril -8:3 2 C.1 4 SH I FT 'f I PIE I SHIFT TH-IF. SHIFT' 'TIIIE 11 1'HLFD SHIFT T111F. a I t PW I[ Y11 THNK M TST NEEDED WRN D I SABLED DiNK ANN wr NEUID 6IR14 111 :ABLED L1IqE RE-E.NOBLE [1ETHC)D LINE TE:T U NE FER isr NMED UP14 5 1.,, .p i! i. F. 1 1 1 1 NL AMN NEFElLP 11IR•111 F I MLED rliiELFD rEI-IF oLLIE MY F WE u 111' .;FI'':.FT D NNN AD LILLA.1',E: HEIGHT E1A`i'LI(;HT T111E I, I 2OBLED RE-HRE,:'T L01.,'OL D I 12HEILF11 DJk;; Ei ITY CIE E OCCOM HLA 1A b L E [1 OWE: D 'S' -,. 1i L E D PH RmUD MTE 9600 FOR. I T',' I1K:-I`)F. M-4- FI I T 1 6.1t, LFI•11";T!--: : RE 202 SE'Af A" Fji*,Llf; PoTE 9M. IMAGE- 12 ons qw. Ulm T= K 175 too h; HE I :.'HT I '111:'HD 1,'Jri'['Ek LI MTER InTEP TD-If- F- F TEI'Ir' 75.:: DEC; F T 2: PHL qO% QUM- 4.562 GALS I IF. ICJ IT = I NC, l 11::.: I-Ii-TER 0 14-i'l-EF.' C1. CIO I TLI"IF = a . S I, El' , F vFTllriRL0 4 .-j C1 0 - P RFHTFE- - 05. u K w% 5-a 5noymo snalooma EII FFO'rUP.E.-,: PFRI(H-IC' 61,11111A]. 151, JUL 17, 20'.' EM I SH 111PIE T-I„T 1-1-3k DD aril -8:3 2 C.1 4 SH I FT 'f I PIE I SHIFT TH-IF. SHIFT' 'TIIIE 11 1'HLFD SHIFT T111F. a I t PW I[ Y11 THNK M TST NEEDED WRN D I SABLED DiNK ANN wr NEUID 6IR14 111 :ABLED L1IqE RE-E.NOBLE [1ETHC)D LINE TE:T U NE FER isr NMED UP14 5 1.,, .p i! i. F. 1 1 1 1 NL AMN NEFElLP 11IR•111 F I MLED rliiELFD rEI-IF oLLIE MY F WE u 111' .;FI'':.FT D NNN AD LILLA.1',E: HEIGHT E1A`i'LI(;HT T111E I, I 2OBLED RE-HRE,:'T L01.,'OL D I 12HEILF11 DJk;; Ei ITY CIE E OCCOM HLA 1A b L E [1 OWE: D 'S' -,. 1i L E D PH RmUD MTE 9600 FOR. I T',' I1K:-I`)F. M-4- FI I T 1 6.1t, LFI•11";T!--: : RE 202 SE'Af A" Fji*,Llf; PoTE 961)0 11- 1 F III•.')NE qw. Ulm T= K 175 too h; HF-:,:;H'r Q? . 0:3, 1-I1:'H.ES MER VOL C, r -, LS MTER 0. CIO I NG*HES TD-If- F- F vFTllriRL0 4 .-j C10 - P RFHTFE- - 05. u K w% 5-a 5noymo snalooma EII FFO'rUP.E.-,: PFRI(H-IC' 61,11111A]. 151, JUL 17, 20'.' EM I SH 111PIE T-I„T 1-1-3k DD aril -8:32 C.1 4 SH I FT 'f I PIE I SHIFT TH-IF. SHIFT' 'TIIIE 11 1'HLFD SHIFT T111F. a I t PW I[ Y11 THNK M TST NEEDED WRN D I SABLED DiNK ANN wr NEUID 6IR14 111 :ABLED L1IqE RE-E.NOBLE [1ETHC)D LINE TE:T UNE FER isr NMED UP14 5 1.,, .pi! i. F. 11 1 1 NL AMN NEFElLP 11IR•111 F I MLED rliiELFD rEI-IF oLLIE MY F WE u 111' .;FI'':.FT D NNN AD LILLA.1',E: HEIGHT E1A`i'LI(;HT T111E I, I 2OBLED RE-HRE,:'T L01.,'OL D I 12HEILF11 DJk;; Ei ITY CIE E OCCOM HLA 1A bL E [1 OWE: D 'S' -,. 1iL ED PH RmUD MTE 9600 FOR. I T',' I1K:-I`)F. M-4- FI I T 1 6.1t, LFI•11";T!--: : RE 202 SE'Af A" 11;;I: ;)D41•I 111-11T I1:'Si-&;LEF- ol-IT6 H[t'M ri DL ED AUT(', tYwERFILL LIMT S4:LED L,',I.) T,p.or,UtOT 11 H L FD HIJF,; TtILI'I 1.11-11T D I ShELED KITD IELIMEM EM R L E I E:,TERNHL. :NVYI' 01,1 SwIPLED OUT EATRIML I NKIT MF PI MLED OLTC:- FIIFL mLr,F-II It I i-.'OBLED OUT() 1,11-dEIi 1) [Si4tElf AUTO EASHMED Fji*,Llf; PoTE 961)0 FOR I T'v III•.')NE STOP B I 1 1 Mr. RE SDAM n" f" 32 011F : V12-',ABLED 11;;I: ;)D41•I 111-11T I1:'Si-&;LEF- ol-IT6 H[t'M ri DL ED AUT(', tYwERFILL LIMT S4:LED L,',I.) T,p.or,UtOT 11 H L FD HIJF,; TtILI'I 1.11-11T D I ShELED KITD IELIMEM EM R L E I E:,TERNHL. :NVYI' 01,1 SwIPLED OUT EATRIML I NKIT MF PI MLED OLTC:- FIIFL mLr,F-II It I i-.'OBLED OUT() 1,11-dEIi 1) [Si4tElf AUTO EASHMED 1 A! TES I 1`11A DHTF HLL j t-,, _ I I C, 0 THF.'T TI('IE L F I-• T L.:T HKI-E ":4-il- Ilk DUPHI I I IF THERT'lH''t. .'(EFF U00700 T f,LI LC T I : 011 pi,w TANI: PROFILE I PT OEFF : . RILL %)Cod. 71-11-11-1 ro I f ',I IETER 0cl 0 PRC-IFILE I PT THNK DIHI'IETEP 9b. I_Ijj FULL I Tr N)' PP^I`l LE I PT 1-1-11-L U.)L 121-1 U J 4.0 IN. W TER I,-IHRN I IA, I ZE: cl IN. Fl..6HT 4.0 11-1. Hll"*H WiATER Llf"JIT: L yHF.,wii%j, 2. LHBEL ',L: 1 .0110ldf,TEP I, I I•it"' AiFRF I TH11*0i WATER., LIIIIT: TER., i . I I vC)L: 1,21-11-11-t 11H,X ,R' L,U.L V,`L I _1000 111t.;H PRODUl"T ERF I LL L I H IT o,,-j L-1 IS DEL I ';ER*,, I.. I M IT I -I LICI 1 1140011300DELP,1E.R", L.11,11T CI C.- 1 LEHI: LIHIT: C4q 0 THNI: TILT 0. OID LFA , HLmP. 1-1 LIMIT: 12 J_ Fj 1 LIMIT: j L.DA): HLARI-1 LIIIIT: ct Ti-,NK TILT Cl • 1jCl L I1! I'l F - P.C.) E: E FF -r3FT U. Uli TOM.'. TILT C1171 PkvFIL 2ET Cl. C, AW,JIFULDT.Hl fHN Tu : (4011IF LINE IIIANIp"LliElt Tol%lKc; N 11;41,41F:AAJED To : NOVIE Till NONE l'o m');-IF LINE hHWIHUED THWII'._; LFo)' 11111 PER16Fill": TO: LI I,1F 120 LEHK 1'1 111 HPI *)L, 1,--:: 1 I zcl LFH) . 1,1 LET 1'91 W f,EPICl-Ii_ TE;;T TYPE r,F PFRIODIi."' 'fE.,'7,,T T-rPll rW,I1N-;L Tf-,. - '. 'I' FH I I 4il-mPl-I FAIL i-;,111111W L TE,:,V FHIL PFP I C", 1, 11 -1 TE:7;T Fr; 11_ Al-HRI-1 Ull-',i;PLEL, i,iI.itkll LoPll D _:i)E:11D E:-.;'I' c - TP T Fr -; 11. I-HIL 6b,F11 DISi;.BLPI, C+ FTESTF' IL HDmMl 1:= F; I., FI' HE, rF-:l F F I- F THI-Il.' TF-T IVF OFF PER TE-7 FF FF JIFF DFL I'vER',, I fc;l D)"FA-V:- 0Ff_ PI-114 THRE HOLD 111. clum DIE!- I pIuf, DIRU',K;LC I CI - 00`-, fVL I VFR`.,, DEL 1 H I N 1•11"Ir' TIIRU:H(,%LrI 10.00', 1 A! TES I 1`11A DHTF HLL j t-,, _ I I C, 0 THF.'T TI('IE L F I-• T L.:T HKI-E ":4-il- Ilk DUPHI I T'r PE: L I :I I•L :7TF• TwM: - TN MTE VKHME FLMT, 0 OIL TAN): N: I L I :FUEL i L L ,,JUEI. WWI N','JP,4-0 L L -'i;FUEL AIARH 2: PHL. t. 1 1,1: F UEL i;D 'll It: L I I :FUEL RAW 11l ;I 1.1 -': FUEL F;Lr',Rll L I _:FUEL. L1 •1 FI EL iif-iRN L IT ;il,• C, i T i-ADYJ,l1:rIRUT L L I i';LAF:l` L I •I :SE ALHPI-1 L I :SIiCtRT L L I L I I i6Y,"F ALT'll UK IS. TQF L i)HTTIIT E: i;.-) AL4:1 I D &W a : I Ll 'I E ; F-F.S2'. Ct-i I L rALHS PF."E'S F:All- L I FUEL ISll LF,;K Fr; I L L 9WI _F• i 1. q: FHB. I ;:.'. L V P F PE:--*. FAIL IkI F --'I N,:LE I 1 1, 1 11: Fl! I- L. 1: 11F L F1 IF-1 FH I L L I L :EN. -,i R CAJT t-LJ4,11 L 9 SEIGUR 0111' MR1 l I :Fl C.-1,1 F F, I L L I E11:-:; -,*, R QUT i;LHRH L I I il-HRTI Al ;Pll Typy P -.-)IJT D;P'l ry-sup QH&LE FLOW, L I j:,,,,HC+ L, I I 0:1-J t LAPI-1 1. 1 WRT ALHRI'l L I FUH, TWEDOE vs"psu, r1ka1 L 14 WORT ALAN) L I-j: FUEL AD-il;ll TF FiLhRllS I, 4: FUEL Pib,=ll L 14 : FUEL MLAWI F-pr.-; Fi i 11. L.1 I :F.CL NL,IRH PE,', H:i I L L1'_ : Vl.!EL ol-AR11 LE;-,,): 1'H I L L FUEL A 'I Fr-dl- L I '1: FUM. mLPM,l DVP-Ir: FAIL L 1:1; L 9 : _ klJ:i'yF; LI' iL;A RP, l L 1 0 UT f -,L.i -,PI-1 ALWOWSS QN-LBO' Rdl LI I :,"-UT Fd.i-iR(l LLEvr FAII L I *-.,' 6 ST i;Liikl-i PAIL L I BEIGOR Or K"mi 1 L I • -'-UT L L 1. 1 L I : :SHORT Al.,4R'll L 1 2 RT , 1. 1:,-;: L I HOFT R TWO i , liLlhf-ll WC + , -';PEN I,lLTC',7 I,IHF L! -;EFL. P-IR T-i'PE : i:-'.T FM-2' a 7I P-1 - 4 1 ii'`; I :-`V T%TE C) -f- 5 6 E ty5 FH --,-: 7- 116 :J it. 9 D E. S LI 9: 0', 7 11 '1 j ifl -;;-17 W -.. '-:-LE w. L F-i-OK"E 1,14 SETUP 5 U I J 11.1':'1 C1 A CP:4 U jj 5 0P' I I 1 5 11 6 I7 71 LI 11 J IJ LI IJ ID 1 11 2 1-1 11 11 11 II 19 1-1 y U u 5 li FI 1-2 U u u 11 11 ij 11 CI LI 11 J 11 11 U 0 LPT f1160-1 5 L 1 11 IJ U C1 I AP IJ 171 2IJ2 ycj, — H(' A. ToFjLE FV1 F H P R U I R F IJ I I F i E F 01 U 1121 L-I I Uu olY, PL`11 llc!'ER 0 ' 0-- L111 Cl.; `1:3 1 IT', P` Ull P*I."- C15 01 1 C 2, 13 U11 1'i 4T E,' F:',' HIP FLXLl HFTF', 1,4 0-1 0.-1 15 2 13.1 1ju clR I- d I ; 1-1` 04 IjI I t:ly iJ5 17 17 FIS IAI 6 1 C-1 '-` S LlIJ H'.• I - 01 C-16 LtIj 12 CIS 2i! 02 ri b LI11 I,lLTC',7 I,IHF L! -;EFL. Prl,'; -.:L'i IjV- 19. 10 59 XV hl.J Pl 41 PH 11 IL .. t 9 : JUN 12 7 PH j :71fl I I J-1 JUL '20. '201 1 11 b C41 HI -;H V*R--1I.dj-.'I' HL.HPH i N 6. --1 CI I a I Fj'I CI l UF.I. Ll',,/EL 12 , PH FED 1. 111'- , 4:38 IT -I JUL. '10- till I 12 CI I PI-I A Cj) A-11 H I ("H WFiTER I 1%11_: I mi . I Ij 9 b F L I E F:',2 I i FEL E D 21-11 1 J LI N 1 7 111 716 P-1 j 1. 1 W 201 1 -11) 14,11 01 f 50 f,.l w E1,1D FP 344E FM-2' a 7I P-1 - 4 iil C) -f- 5 6 E ty5 FH --,-: Prl,'; -.:L'i IjV- 19. 10 59 XV hl.J Pl 41 PH 11 IL .. t 9 : JUN 12 7 PH j :71fl I I J-1 JUL '20. '201 1 11 b C41 HI -;H V*R--1I.dj-.'I' HL.HPH i N 6. --1 CI I a I Fj'I CI l UF.I. Ll',,/EL 12 , PH FED 1. 111'- , 4:38 IT -I JUL. '10- till I 12 CI I PI-I A Cj) A-11 H I ("H WFiTER I 1%11_: I mi . I Ij 9 b F L I E F:',2 I i FEL E D 21-11 1 J LI N 1 7 111 716 P-1 j 1. 1 W 201 1 -11) 14,11 01 f 50 f,.l w E1,1D FP ifil-• viAH H-411 1,111H iF; iil C) -f- 5 5 U 7- 116 :J it. 9 D E. S LI 9: 0', 7 11 '1 j ifl -;;-17 5 1,14 1CI 21-113 ?08 5 U I J 11.1':'1 C1 A CP:4 U jj 5 0P' I I 1 5 11 6 I7 71 LI 11 J IJ LI IJ ID 1 11 2 1-1 11 11 11 II 19 1-1 y U u 5 li U u u 11 11 ij 11 CI LI 11 J 11 11 U 0 5 L 1 11 IJ U C1 I u r 11 li IJ 171 2IJ2 ycj, — U w! 04 904 U U Prl,'; -.:L'i IjV- 19. 10 59 XV hl.J Pl 41 PH 11 IL .. t 9 : JUN 12 7 PH j :71fl I I J-1 JUL '20. '201 1 11 b C41 HI -;H V*R--1I.dj-.'I' HL.HPH i N 6. --1 CI I a I Fj'I CI l UF.I. Ll',,/EL 12 , PH FED 1. 111'- , 4:38 IT -I JUL. '10- till I 12 CI I PI-I A Cj) A-11 H I ("H WFiTER I 1%11_: I mi . I Ij 9 b F L I E F:',2 I i FEL E D 21-11 1 J LI N 1 7 111 716 P-1 j 1. 1 W 201 1 -11) 14,11 01 f 50 f,.l w E1,1D PREI-I I U11 BR(,'-I-IEE 1 LL: ER 9: DLEHLYZ ICI: BLEWN Prl,'; -.:L'i IjV- 19. 10 59 XV hl.J Pl 41 PH 11 IL .. t 9 : JUN 12 7 PH j :71fl I I J-1 JUL '20. '201 1 11 b C41 HI -;H V*R--1I.dj-.'I' HL.HPH i N 6. --1 CI I a I Fj'I CI l UF.I. Ll',,/EL 12 , PH FED 1. 111'- , 4:38 IT -I JUL. '10- till I 12 CI I PI-I A Cj) A-11 H I ("H WFiTER I 1%11_: I mi . I Ij 9 b F L I E F:',2 I i FEL E D 21-11 1 J LI N 1 7 111 716 P-1 j 1. 1 W 201 1 -11) 14,11 01 f 50 f,.l w E1,1D bXJ TF1•V JUL '?, Ci . _1.111 1 '_ : Ci E%J,71 JUL 20. 2W 1 H 1-6W PROC10_1 "Lr43-1 YUEL 'AARl"I JUL 20 yijli I IT,,ol_ I L, 1 UEL L FtT1 l 0 10 : Ni I Ci a: 11 41 PROBE OuT 31. U. 2W 1 19. 201(l j: 4- (.srl I 1H .Ch I U: 1-1:2 J UL 1111, :NI, 7,011 1 1 .1 140-fl-Ir" 1:1JE:. 1.E '' ;Fl_ 20. 201 1 1 1 m Am kPOI::E C)UT JUL '20. bXJ TF1•V JUL '?, Ci . _1.111 1 '_ : Ci E%J,71 i 12 III F FB -.,1 :'_111 3, 5F PI -1 LCAJ TFsIP X'T I"f. 2011,1 1(1:7(4 i4f EEL, FVi;_;::+'.' 2 YL '2 C FUEL CWQ DOT 19. 10:.I? Hf"I t - * - -: END ':W ;- - -. . JUL 20. 2W 1 H 1-6W PROC10_1 "Lr43-1 YUEL 'AARl"I JUL 20 yijli I IT,,ol_ I L, 1 UEL L FtT1 l 0 10 : Ni I Ci a: 11 41 PROBE OuT 31. U. 2W 1 mV 4-1 JUL 20. _1.11 1 1 1 ::::5 411 I'?. :: I-I I I'l I U: 1-1:2 i 12 III F FB -.,1 :'_111 3, 5F PI -1 LCAJ TFsIP X'T I"f. 2011,1 1(1:7(4 i4f EEL, FVi;_;::+'.' 2 YL '2 C FUEL CWQ DOT 19. 10:.I? Hf"I t - * - -: END ':W ;- - -. . 9TP SKWWR 0 c OW, 20. Kn011 I I :50 141 L I if-) • " * L uv; L YUEL 'AARl"I JUL 20 yijli F12F-L. APP 9TP SKWWR 0 c OW, 20. Kn011 I I :50 141 L I if-) • " * RUFti:'F.-r L -1:FTIL. fAl%jlJ JUL FULL F1.11"L. okvRm or,P L-o) ) ) ) :, j I . ;. EPjj , . , - EP-ORT lu ElqfJOR 7)AIJ-011 I.IT. L)RHEt.k . 0 20. 11,11 1 1 1 S'D, r• FIJFL AL.AF.11 111L _'173 Hl I I I I UID* '* - * - RFPC+.T U;ER'jok. I JI_lL '2 I. 21.11 I 1I t4'I Fl 11'1_ L 11 1E P41 All "Cl. ",ull 11:5. FUEL. t;fjIJ*I T-11. Z.,I-I. '21-A I I I FIIF'I_ oLHEI-I I'D I w END LH'r " Pj-* , . i-il-API-I 1. 1 1 : C' I ;P :3 P C? UT i'ILARH FULL L,-iRTI FUEL ol,RM r .,41* I rl I PE f UK C d FUEL All.. Fuu. PAPA-1 NMI HlYMN RMAT SWOR ow* ALARM I 111- 0: 1 1 1 2 4.1 FUEL JI-11• FUEL :41-f;kl-1 I., I '- - ;PrHsp.P FUEL ALARI-1 T Ul, FUEL FAARI'l JUL -.-Cil I I I : 'J.-I CUM. 0,.'T L-010 DAD - '. Ti -NI: iiD-;Rll 1 :3: D'.31. lll--V-Fr, JIIL 17. z012 i'J'l JIJL :7- tl:.`6 HI"I T 0: VSL PROBE OUT 30L 17. 2012 8:56 all T MNL D.IfIVEN L. J IJL I W-T Yll< iljikfl T Z:PNL DEL. NFEDFli JUL 17. -'ill _ 0,.:1.7 1--1 I I-J-TAIC of t Rll T 2: PNI. 1ill. 17. 201w 8:57 oil INVAM T 1-,[qL Po AP 721 1_I IIC1IHST .4G I 2(* H -ST, fi DopmBER P&I 66 1 FUEL M01 JUL 17, *-YII.? 9: 0', I'd-I ILIL 17. :z-ij*-, JUL -'012 ":5> W"I T I I' I :PROBF 611T T 2SUFTEN "WO ALARM NEEDED LI 20181? 1 R -I G D wMWER Y"N FUEL A'-,.ARH 17. Crl 9: 08 PAI" L I WIS. 8TP W SUPIPTI : UNL FIjFI- AL(,Rl,l JUL In D12 9: 0'.-j Wl FUEL HLARII JUL 17, 5; AI I I ? - 2c, I'-, AH Id-- '('AMC 4API'l Ab-RH PiLriRl'l T I :LINE STF- STP SWffPAMECWTFUELAlARM D EVER 101.1 L. JUL 17. 21ji--', JUL i7- 201", ?:04 All 7-1-IL ILJ[, i ::.;)R4012H ,:;T. L STPPAI,FP'SF I ELI:1. ",:H STP SNIP L 6:0._L (*J PIJEL AL,R[1 FUEL7 -0 12 . . : I,j F4,19:05 HPIJUL J1.11. I' ll. T T 1 :PP, PF iJ)T T :::'.UDT, EN SEituOR ALARM ol-ARHL9:DISP DEWMER PWI FUEL sLAR'l FUEL111L17. '201 UE, iih JUL 1','. 201'-' 11-12 1, 2: U A, mNl,l FOEL Hl.hk•l JUL l?'. -Cll 9: Oh AH rum. fomml jI.jL In 21:11<` :I T-I 3 0 L I I I 2?;, 13-1 J tiLp1 :3",:R L &M. AIV-4u!-4 rllFl ADAPH FUEL 1japh wL I?. zol', I:i rill I i'1 -Tr INK. ADiRl IN sum, Lt. - iU-,Rt-1 117. zcfi , JUL I?. AD JUL 17. -'OL' I hl-CANK PROBE L 1:YT)L ANN CF's s, SNQV- PME 11Q, JUL. 17. T 3: EfL. L 91011, 9-11:1 LUO TaT KAMM P914 C +1 r,FIVSE 1111_ 17. 012 01 JL 17 1 1 JUL 17. 2101, 5:1:-, '41 r IEWN." 1 L IA',: OSP 174,:,' JTP SUIP DOPEWER PsH 9:1t, rill lY1' i. iLi-,Rf-1 JUL 1?. '..,012 JUL 11.1. HE I ( HT WATU, cl,00 11'si:HE2. TEII- I END JUL ANN iDCi I rI :: HE2'. Dfsf-FN-Zk TEMP DEC, F GPIs -(,k FIJEJ- i-i1j-iF'•) JUL 1 7. :'Il I '' 'D I iA-1 JUL i'l, '2012 9 1'2 41 TO NET I 3 0 L I I I 2?;, 13-1 J tiLp1 :3",:R L &M. AIV-4u!-4 rllFl ADAPH FUEL 1japh wL I?. zol', I:i rill I i'1 -Tr INK. ADiRl IN sum, Lt. - iU-,Rt-1 117. zcfi , JUL I?. AD JUL 17. -'OL' I hl-CANK PROBE ALAPIA 1. AWN SUBUK OUT HLAR'l DUI_ - 17. mi'l IN-Tfilll' !--,L;iRN r 2 : PNI. T 2:PNI- I WO Ll VIE = -197t5 1:i-U -, HE I (41T = • 1 . !-A 1 1,11::HES 6"TER 0 00 MOM TFI•IP = e -9 .'—, DEC,' F I N".1 - JLII. 17 4 All I u? 19 (HLS tE KMT By 29 1 W ES 65TER 0,00 "KAES, TDIP 0 CE,-'4 F I-j,*-,,F.-E(,EiE= 5 7 L4, Tl:! HET 1 15708 fli-T61-W *iLfiPl• -- JUL 1?. 201-, 9::;5 till PROBE MIT 111L, I.. it1 :!:;Db Hil UNL JUL 17. 9::A., Al r I : UNL, 1•11:'FEii2E i iE 1 f-:,HT k/eXIIIE HE I ';HT 1P.::; IJATEP 14:IiES TRIP x•0.2 DE,*,' F F(:; NET I I FmSTQ P 721 001.3 E*. H Gt. I - L 11 :2T. STHTJIV i iE 1 f-:,HT z 1)."'TER TUIP C'O. 1 DEC; F(:; NET I I FmSTQ P 721 001.3 E*. H Gt. I - L 11 :2T. STHTJIV SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing of UST spill containment structures. The completedform and printouts from tests (ifapplicable), should be provided to the facility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: #7721 Fastrip #22 1 Date of Testing: 7/17/2012 Facility Address: 4013 South H Street, Bakersfield, CA 93304 Facility Contact: Omero Garcia Phone: 661- 393 -7000 Date Local Agency Was Notified ofTesting: 6/19/2012 Name of Local Agency Inspector (ifpresent during testing): Ernie Medina 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. Technician Conducting Test: Bryan A Self Credentials': 0 CSLB Contractor 0 ICC Service Tech. 9 SWRCB Tank Tester Other (Spec) License Number(s): CSLB 4804904 ICC #8022804 -UT Tank Tester # 11-1756 3. SPILL BUCKET TESTING INFORMATION Test Method Used: x Hydrostatic Vacuum Other Test Equipment Used: Lake Test Equipment Resolution: 0.0625" Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 Regular 2 Super 3 Diesel 4 Bucket Installation Type: Direct Bury M Contained in Sump Direct Bury OO Contained in Sump Direct Bury gContained in Sump Direct Bury 1.1 Contained in Sum Bucket Diameter: 12.00" 12.00" 12.00" Bucket Depth: 14.25" 14.00" 14.50" Wait time between applying vacuum /water and start of test: 5 min. 5 min. 5 min. Test Start Time (T,): 9:00 am 9:00 am 9:00 am Initial Reading (Ri): 8.25" 8.00" 8.25" Test End Time (TF): 10:00 am 10:00 am 10:00 am Final Reading (RF): 8.25" 8.00" 8.25" Test Duration (TF — Ti): 1 hour I hour 1 hour Change in Reading (RF - Ri): 0.00" 0.00" 0.00" Pass /Fail Threshold or Criteria: 0.0625" 0.0625" 0.0625" Test Result: 0 Pass Fail 0 Pass Fail x Pass Fail Pass Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -upfor.failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and infull compliance with legal requirements. Technician's Signature: e", LA -wllr Date: 7/17/2012 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. SITE PLOT PLAN for: LEGEND015- 021 -03022 ESO EMERGENCY SHUT -OFF 721/ #781 FASTRIP #22 OFA OVERFILL ALARM 4013 SO. "H" STREET PRODUCT VAPOR SPILL SPILL NEIRER BAKERSFIELD, CA 93304 ANNULAR i FIRE EXTINGUISHER GAS METER SHUT -OFF 4F WATER METER SHUT -OFF O HEALY CAS EVACUATION MEETING POINT 1 2 19 1721 "L" SENSOR SETUP: 3 - 12,000 GALLON 1 L1 87 STP LISTS L2 87 ANNULAR L6 (tRX_ SL of ESO L3 91 STP OH Liu TP, 721 L4 91 ANNULAR L4 A VOL. 91 1 1 1 17 L5 DSL STPLL31L6DSLANNULAR L2 A srR_ B7 L9 UDC 9/10 L Ll L10 UDC 11/12 1 16 is Lll UDC 13/14 9 L12 UDC 15/16r=::Tl L13 UDC 17/18 L14 UDC 19/20 1 IRC 1IT BREAKER .6 Pry 0 TLS350 781 "L" SENSOR SETUP: Ll 87 -1 STP FIRE L2 87-1 ANNULAR HYDRANT L3 DSL STP L4 DSL ANNULAR L5 87 -2 STP z L6 87 -2 ANNULAR L7 91 STP L8 91 ANNULAR L9 UDC 1/2 L10 UDC 7/8 Lll UDC 5/6 L12 UDC 3/4 L13 NO. TRANS L14 SO. TRANS 87 -1 87 -2 91 DSL A Y' 1.: 405-330-13-00— 781 2 (I 6 L liv PATE RCV6ggS SCALE: Lll I I 10 4 12,000 GAL BAS N CH J 101 S T HILL CO 3101 STATE AD LISTs BAKERSFIELD CA., SITE PLAN FASTRIP - 7 -721 mron CONVENIENCE MARKET FOR OJAMIESONHILLCOMPANY 4013 S. H STREET vmrm LANG NOO BAKERSFIELD, CALIFORNIA OF 1 fIDFh #fIDEti 0 r10 00 C0 uSL, UST Job Order/ Invoice # z 3 Z Ca BUILD WITH CONFIDENCE" co..nu..cwu. coe.m.ecs Date Call Made Time To Whom =tation Control Number Repair Date Invoice DateTollFree #: 1 -800- 339 -9930 I ,Z 9- /-?-- "e- Name Confidence UST Construction Inc. Work performed at Station number: _7 7Zl FiNS +ri Street 16250 Meacham Road 2 Street yG\3 HmJ 0 City Bakersfield, Ca 93314 J City o, Ktrs ,, StateC Zlp 93'30 Terms Store number: 2 Description of work performed: I G '1 10i.A e ' 1 cc K. f c, rG. t luc. e O Z r c le 1 L. zcl G va +L-s.. 1) ' c ICAA c c e I ,b C, ,F_x r le, r c- Sep - Z Iry GS L, eck C5 u0c J, c. CS C) tit _ Labor Date Name / Number Class Hours Hourly Amount Arrived Departed Labor Travel Total Rate AM AM PM PM 1 .•-/y AM AM PM PMtJ AM AM PM PM Employee Signature Date Vendor Signature Date Contractor Supplied - Materials - Rentals Amount Sub -Total Quantity Total A Labor t ,•CK-C_4 X 1 u `,' U L, zo Total B Material Ka j4af u Total C Mileage 1 3 e Total Amount Invoice A + B + C Accounting Breakdown Mileage Miles Rate Total Sub Total Handling % Tax ( If applicable) Total C Total B May we please have your comments regarding service / equipment provided by the above named contractor: Store yoyee i ted Name Store E yee gnat Date App, ved By Date r 7T jl i E - CAN413Y